St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SPIRONOLACTONE 5 MG/ML PO SUSP - COMPOUNDED

Facility

$1.00

Service Code	NDC 9999701384
Hospital Charge Code	9999701384
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.50
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

Splenectomy

Facility

$66,917.23

Service Code	APR-DRG 6502
Min. Negotiated Rate	$20,122.00
Max. Negotiated Rate	$66,917.23
Rate for Payer: Affinity Essential Plan 1&2	$66,917.23
Rate for Payer: Affinity Essential Plan 3&4	$66,917.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,740.99
Rate for Payer: Amida Care Medicaid	$29,740.99
Rate for Payer: EmblemHealth Essential Plan 1&2	$66,917.23
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,740.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,740.99
Rate for Payer: Fidelis Qualified Health Plan	$35,689.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,740.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,740.99
Rate for Payer: Healthfirst Commercial	$34,090.00
Rate for Payer: Healthfirst Essential Plan	$66,917.23
Rate for Payer: Healthfirst QHP	$20,122.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,740.99
Rate for Payer: SOMOS Essential	$66,917.23
Rate for Payer: United Healthcare Essential Plan 1&2	$66,917.23
Rate for Payer: United Healthcare Essential Plan 3&4	$66,917.23
Rate for Payer: United Healthcare Medicaid	$29,740.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,740.99

Splenectomy

Facility

$54,868.05

Service Code	APR-DRG 6501
Min. Negotiated Rate	$15,238.00
Max. Negotiated Rate	$54,868.05
Rate for Payer: Affinity Essential Plan 1&2	$54,868.05
Rate for Payer: Affinity Essential Plan 3&4	$54,868.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,385.80
Rate for Payer: Amida Care Medicaid	$24,385.80
Rate for Payer: EmblemHealth Essential Plan 1&2	$54,868.05
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,385.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,385.80
Rate for Payer: Fidelis Qualified Health Plan	$29,262.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,385.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,385.80
Rate for Payer: Healthfirst Commercial	$24,714.00
Rate for Payer: Healthfirst Essential Plan	$54,868.05
Rate for Payer: Healthfirst QHP	$15,238.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,385.80
Rate for Payer: SOMOS Essential	$54,868.05
Rate for Payer: United Healthcare Essential Plan 1&2	$54,868.05
Rate for Payer: United Healthcare Essential Plan 3&4	$54,868.05
Rate for Payer: United Healthcare Medicaid	$24,385.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,385.80

Splenectomy

Facility

$132,317.95

Service Code	APR-DRG 6504
Min. Negotiated Rate	$58,807.98
Max. Negotiated Rate	$132,317.95
Rate for Payer: Affinity Essential Plan 1&2	$132,317.95
Rate for Payer: Affinity Essential Plan 3&4	$132,317.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$58,807.98
Rate for Payer: Amida Care Medicaid	$58,807.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$132,317.95
Rate for Payer: EmblemHealth Essential Plan 3&4	$58,807.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$58,807.98
Rate for Payer: Fidelis Qualified Health Plan	$70,569.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$58,807.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$58,807.98
Rate for Payer: Healthfirst Commercial	$115,696.00
Rate for Payer: Healthfirst Essential Plan	$132,317.95
Rate for Payer: Healthfirst QHP	$70,063.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58,807.98
Rate for Payer: SOMOS Essential	$132,317.95
Rate for Payer: United Healthcare Essential Plan 1&2	$132,317.95
Rate for Payer: United Healthcare Essential Plan 3&4	$132,317.95
Rate for Payer: United Healthcare Medicaid	$58,807.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58,807.98

Splenectomy

Facility

$74,073.58

Service Code	APR-DRG 6503
Min. Negotiated Rate	$29,363.00
Max. Negotiated Rate	$74,073.58
Rate for Payer: Affinity Essential Plan 1&2	$74,073.58
Rate for Payer: Affinity Essential Plan 3&4	$74,073.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,921.59
Rate for Payer: Amida Care Medicaid	$32,921.59
Rate for Payer: EmblemHealth Essential Plan 1&2	$74,073.58
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,921.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,921.59
Rate for Payer: Fidelis Qualified Health Plan	$39,505.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,921.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,921.59
Rate for Payer: Healthfirst Commercial	$47,052.00
Rate for Payer: Healthfirst Essential Plan	$74,073.58
Rate for Payer: Healthfirst QHP	$29,363.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,921.59
Rate for Payer: SOMOS Essential	$74,073.58
Rate for Payer: United Healthcare Essential Plan 1&2	$74,073.58
Rate for Payer: United Healthcare Essential Plan 3&4	$74,073.58
Rate for Payer: United Healthcare Medicaid	$32,921.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,921.59

STATUS ASTHMATICUS

Facility

$232.28

Service Code	EAPG 00579
Min. Negotiated Rate	$168.94
Max. Negotiated Rate	$232.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$168.94
Rate for Payer: Healthfirst Commercial	$232.28

STERILE WATER FOR DILUTION IJ SOLN

Facility

$0.12

Service Code	NDC 0409488710
Hospital Charge Code	0409488710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

STERILE WATER FOR DILUTION IJ SOLN

Facility

$0.00

Service Code	NDC 5024290124
Hospital Charge Code	5024290124
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

STERILE WATER FOR DILUTION IJ SOLN

Facility

$0.00

Service Code	NDC 5024290124
Hospital Charge Code	5024290124
Hospital Revenue Code	250
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

STERILE WATER FOR DILUTION IJ SOLN

Facility

$0.12

Service Code	NDC 0409488710
Hospital Charge Code	0409488710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.53

Service Code	NDC 6332318510
Hospital Charge Code	6332318510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.19

Service Code	NDC 6425302091
Hospital Charge Code	6425302091
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.16

Service Code	NDC 6425302030
Hospital Charge Code	6425302030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.37

Service Code	NDC 0641614710
Hospital Charge Code	0641614710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.37

Service Code	NDC 0641614710
Hospital Charge Code	0641614710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.16

Service Code	NDC 6425302030
Hospital Charge Code	6425302030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.00

Service Code	NDC 0338001306
Hospital Charge Code	0338001306
Hospital Revenue Code	250
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.01

Service Code	NDC 0338001304
Hospital Charge Code	0338001304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.00

Service Code	NDC 0338001306
Hospital Charge Code	0338001306
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.01

Service Code	NDC 0338001304
Hospital Charge Code	0338001304
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.06

Service Code	NDC 0409488750
Hospital Charge Code	0409488750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.06

Service Code	NDC 0409488750
Hospital Charge Code	0409488750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.06

Service Code	NDC 0409488725
Hospital Charge Code	0409488725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.06

Service Code	NDC 0409488725
Hospital Charge Code	0409488725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

STERILE WATER FOR INJECTION IJ SOLN

Facility

$0.06

Service Code	NDC 0409488724
Hospital Charge Code	0409488724
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

Know your out-of-pocket cost for care.

All Charges